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SIBO: Small Intestinal Bacterial Overgrowth

Over the holiday season I had a deluge of teenagers and a few adults come in with this diagnosis: SIBO.

What is SIBO, how is it diagnosed, why does it occur, and how do we treat it?

If you’ve been reading health journals lately, studies are now indicating much of our health is about the gut. It makes sense since the gut is our biggest organ and if something is amiss one of the signs that our gut activity has been compromised.

SIBO is diagnosed when there is an abnormal or large amount of bacteria in the small intestine. It is thought to occur when the body’s own defense mechanisms fail to keep the normal amount of gut bacteria.

The symptoms of SIBO may range from nothing to bloating and discomfort after meals to constant bloating, discomfort and gas, diarrhea or constipation. Whatever your symptoms are, make sure to seek out medical advice for a diagnosis.

SIBO is normally diagnosed by a hydrogen breath test. An individual is given a solution to drink such as lactulose and then a breath test is administered to assess the presence of gas such as methane or hydrogen. If someone had a healthy gut, there would not be either of these two gases in the breath till after 2 hours or the approximate time it would take for the lactulose to travel from the mouth to the large intestine where bacteria feed on it and release gas.

If someone has SIBO there would be a positive test within 90 minutes of drinking the lactulose since the bacteria would be higher in the gut or the small intestine.

How does SIBO occur? Many different theories abound and many link IBS (irritable bowel syndrome) with being SIBO incognito.

Is it due to overuse of antibiotics, diet balance, types of food, none or all of the above?

No one exactly knows but I have my own theory.

I write blogs based on my own experiences, those of my patients and what I see on a regular basis. In the last year and especially the last few months I’ve seen more patients with diagnosed SIBO than in all of my almost 20 years in private practice combined which I don’t think is a coincidence.

Is this because more physicians are testing and diagnosing SIBO when a patient complains about symptoms? The answer may be a combination of the testing and our diets.

We were not made to physically eat all the starchy processed carbs we consume, especially the amount adolescents are consuming.

Since carbs abound in our food supply and protein choices are scarce in our school cafeterias and snack bars, seeing higher rates of SIBO does not surprise me. Muffins, donuts, granola bars, bags of chips are prevalent, and plain nuts, yogurt, whole fruit are rarely an option.

Let’s break it down for simplicity:

If your body needs 150-250 grams of total carbohydrate (the approximate amount a person with a normal metabolism might require) and you are eating 300-400 grams which is easy to do, your gut is not a happy camper since it does not know how to handle/process the extra carbohydrates.

The bacteria in your gut love to feast on the additional carbohydrates and sugar. If the body cannot process your food in a timely manner bloating, gas, GERD (reflux) can result.

Sometimes a combination of having antibiotics a few too many times, too many carbs and/or alcohol, and a medical illness that compromises your gut in some way may be the perfect storm for SIBO to occur.

Medications can help initially with symptoms, but how can you help prevent SIBO and keep your gut healthy and happy for the long term?

Keep processed, starchy carbohydrates to a minimum – if it’s crunchy, salty, sweet and/or and something readily available at a convenience store or in the middle aisles of the grocery store it is optimal to avoid these foods – chips, cookies, candy, etc.

Eat regular meals and snacks with protein along with carbs that do not need a label (fruits, veggies, etc.). Eating protein at regular intervals during the day will keep you blood sugar balanced and brain happy so you won’t be tempted to eat whatever opportunistic carbs are lying around the office, dorm room, or kitchen.

Consume foods that nurture your gut health – regularly consume fermented foods such as sauerkraut, yogurt, and kefir – to help keep the good gut bacteria prevalent. Fermented foods contain microorganisms that are healthful and contribute to strengthening the digestive and immune systems.

Be mindful of your daily diet. This may sound like a no-brainer but the last few weeks in the office I’ve observed how everyone is so busy with their lives and schedules that food becomes a low priority. Think through your week and what you want your meals and snacks to look like and then organize it accordingly with grocery shopping, planning, etc.

Edward Stanley (1826-1893) stated so eloquently:

“Those who think they have no time for healthy eating will sooner or later have to find time for illness.”

Since food is at the foundation of Maslow’s triangle think through how you are going to plan your meals on a day-to-day basis so SIBO is not in your future, and if you have SIBO already carefully plan how you can find your way back to optimal gut health.

One comment

Seems to me that the difference between 90 minutes and 2 hours is not great. But one cannot argue with this pattern of symptoms that is abounding. Thank you again for the reminder to keep it simple and homegrown.